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MKSAP: Key Points > Neurology key points > Flashcards

Neurology key points Flashcards

1
Q

Define primary vs secondary HA

A

Primary: biologic disorder of the brain. Secondary: identifiable organic causation

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2
Q

Do primary or secondary HA often have clinical red flags?

A

Secondary

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3
Q

Describe use of neuroimaging studies in patients w/ stable HA that meet criteria for migraines

A

Don’t need imaging

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4
Q

Initial Mx of thunderclap HA?

A

CT head

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5
Q

Mx of thunderclap HA when initial CT head is normal?

A

LP

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6
Q

Etiology of most thunderclap HAs 2/2 SAH?

A

Rupture of previously unidentified saccular aneurysms. These account for 85% of SAH a/w thunderclap HA

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7
Q

Initial drug used as stroke prevention s/p carotid and vertebral artery dissection?

A

ASA

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8
Q

Idiopathic intracranial HTN is MC managed with what class of drug? Name 2 examples of drugs in this class

A

Carbonic anhydrase inhibitors. Examples: acetazolamide, topiramate (weak CA inhibitor effects)

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9
Q

What treatment is highly effective in resolving HA 2/2 CSF leak that fail to respond to conservative management?

A

Epidural blood patching

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10
Q

DOC for initial Mx of trigeminal neuralgia?

A

Carbamazepine

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11
Q

Response rate for carbamazepine in trigeminal neuralgia?

A

> 50%

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12
Q

What percentage of patients with trigeminal neuralgia don’t respond to medication? What form of Tx should you consider in these cases?

A

30%, surgical therapies

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13
Q

In which patients should you consider medication overuse HA?

A

Those taking analgesics, ergotamines, or triptans more than 10 days per month

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14
Q

What 2 classes of medications have very high rates of medication overuse HA and thus should be avoided in Mx of HA?

A

Opioids, butalbital compounds

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15
Q

Usage of the POUND mnenomic can be helpful in proper Dx of migraine. What are these criteria, and how many are required for diagnosis of migraine?

A

If more than 3 of these criteria are fulfilled, patients can be Dx w/ migraine w/o further eval.

  1. Pulsatile
  2. One day in duration (episodes lasting 4-72 hr if unTx)
  3. Unilateral
  4. N/v
  5. Disabling
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16
Q

3 most effective medication classes for acute migraine therapy?

A

NSAIDs, triptans, dihydroergotamine

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17
Q

What is the most cost-effective initial choice for acute migraine therapy?

A

NSAIDs

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18
Q

What are the preferred NSAIDs and/or triptans in acute management of migraines?

A

There is no preferred drug in any of these classes

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19
Q

There are 2 main criteria for use of preventive therapy in migraine HA patients. Meeting either of these suggests that you should use preventive agents. Name the two criteria

A
  1. 8 or more total days of migraines per month

2. 4 or more days of disabling migraines per month

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20
Q

3 drugs that are often successful in initial treatment of acute tension HA?

A

APAP, ASA, NSAIDs

21
Q

DOC for prevention of tension HA?

A

Amitriptyline

22
Q

What imaging should be performed in patients with suspected cluster HA? Why?

A

MRI brain, to r/o structural HA mimicking cluster HA

23
Q

2 first-line therapies for acute cluster HA?

A
  1. Oxygen inhalation

2. SubQ sumatriptan

24
Q

Describe timeline of primary cough HA?

A

Develops abruptly after a cough, remains severe for seconds to minutes, then fades

25
Q

What drug does primary cough HA typically respond to?

A

Indomethacin

26
Q

Neuroimaging is indicated in patients with mild TBI only if they possess at least one of the following 6 characteristics. Name those characteristics

A
  1. Repeated vomiting
  2. Dysarthria
  3. Worsening HA
  4. Drowsiness
  5. Persistant confusion
  6. Focal neuro findings
27
Q

Name 3 reasons that CT is preferred to MRI in initial neuroimaging of TBI

A
  1. Cheaper
  2. More widely available
  3. More sensitive in identification of skull Frx
28
Q

First step in management of an athlete suspected of sustaining mild TBI?

A

Remove them from play!

29
Q

When can an athlete suspected of sustaining mild TBI be allowed to play contact sports again? (2 requirements)

A
  1. Return to cognitive baseline

2. ASx and not requiring any meds to treat trauma-related Sx

30
Q

Patients in what age group have the highest rates of morbidity, mortality, and hospitalization s/p TBI?

A

Older than 75

31
Q

Name 3 preventive measures helpful in preventing TBI in patients older than 75

A
  1. Avoid overmedication
  2. Regular physical activity
  3. Living area modifications
32
Q

Describe general management of postconcussive syndrome

A

Supportive/rehabilitative. Can direct medical Tx at specific Sx

33
Q

Describe prognosis of epidural hematoma without immediate surgical evacuation

A

Terrible- death often w/in hours

34
Q

Describe prognosis of epidural hematoma with immediate surgical evacuation

A

Excellent- bc underlying brain tissue is often uninjured

35
Q

Subdural hematomas commonly occur in the absence of significant trauma. This is particularly true in what 2 groups of patients?

A
  1. Elderly

2. Those taking anti-coagulants

36
Q

2 general modalities of Tx of subdural hematoma? (choice is dictated by presentation)

A
  1. Obs

2. Surgical evacuation

37
Q

Describe the major difference btwn simple and complex partial seizures

A

Both are partial (starting in one specific area of the brain). Simple partial don’t have any change in consciousness, while complex partial have a disturbance in awareness

38
Q

Give 2 examples of semi-purposeful behaviors that can be seen during complex partial seizures

A
  1. Lip smacking

2. Finger fumbling

39
Q

Name 2 key differences in absence seizures vs complex partial seizures

A

Absence seizures are shorter (less than 5 sec, vs 30-90 sec) and are not associated with post-ictal confusion

40
Q

MC type of focal epilepsy?

A

Temporal lobe epilepsy

41
Q

Is the cause of most focal epilepsy found?

A

Nope

42
Q

Idiopathic generalized epilepsy is genetic and accounts for what fraction os all epilepsy syndromes?

A

1/3

43
Q

3 possible seizure manifestations of idiopathic generalized epilepsy?

A
  1. Tonic-clonic
  2. Absence
  3. Myoclonic
44
Q

Juvenile myoclonic epilepsy is classically characterized by what? Name 2 additional types of seizures that can be present

A

Morning myoclonus. Other possibilities include tonic-clonic or absence seizures.

45
Q

2 components of immediate management of a seizure?

A
  1. Stabilization of patient (attention to airway and VS)

2. Rapid ID of any reversible causes

46
Q

Any patient with an unprovoked seizure should have neuroimaging. Which of these patients need an urgent CT w/o contrast? (3 characteristics)

A

Patients with any of the following require non-contrast CT to r/o a bleed.

  1. Focal neuro deficits
  2. Impaired mental status
  3. Head trauma
47
Q

Management of a single provoked seizure?

A

Usually don’t need AED. Instead focus on fixing the underlying cause.

48
Q

Dx of psychogenic non-epileptic seizure?

A

Inpatient video EEG

MKSAP: Key Points (6 decks)

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